Ten years of the National breast cancer screening programme Dora

Priporočila za vzpostavitev presejalnih programov za raka dojk je leta 2003 izdala Evropska komisija in države članice Evropske unije pozvala, da jih vzpostavijo do leta 2008. V Sloveniji od leta 2008 deluje Državni program za raka dojk DORA, ki je konec leta 2017 vključeval vse slovenske ženske iz ciljne skupine. Ženske v starosti od 50 do 69 let so vsaki dve leti pisno vabljene na presejalni pregled z mamografijo, ki omogoča odkritje še netipnih sprememb v dojki. Ob sumljivih spremembah na mamografiji so povabljene na nadaljnjo obravnavo, če je odkrit rak dojke, pa tudi na zdravljenje. Od leta 2018 v okviru programa deluje 21 mamografov v 16 stacionarnih in 3 mobilnih presejalnih enotah, kjer se opravljajo presejalne mamografije, in 2 presejalno- diagnostična centra za nadaljnjo obravnavo žensk in zdravljenje raka, odkritega v presejanju. Program DORA deluje v skladu z visokimi standardi Evropskih smernic za zagotavljanje kakovosti presejanja za raka dojk in zagotavlja enako obravnavo za vse udeleženke v katerikoli presejalni enoti v Sloveniji. Cilj presejalnega programa je ob vsaj 70-odstotni udeležbi žensk doseči znižanje umrljivosti za rakom dojk v ciljni populaciji za 25–30 %. Letno merjeni kazalniki kakovosti programa kažejo, da je program učinkovit in vodi k omenjenemu cilju. Značilnosti slovenskega organiziranega programa so: centraliziran populacijski program, vabljenje žensk z vnaprej določenim terminom slikanja, dvojno odčitavanje, konsenz konferenca, nadaljnja obravnava je del presejalnega postopka, multidisciplinarni sestanki, presejalni register z enotno aplikacijo za vnašanje vseh presejalnih korakov, od vabila do mamografij in nadaljnje obravnave, nadzor kakovosti dela radioloških inženirjev in radiologov, stalen strokovni nadzor nad izvajalci programa in letno merjenje kazalnikov kakovosti programa.In 2003, European Commission issued recommendations for breast cancer screening programme implementation and called upon member states to establish it untill 2008. Slovenian national breast cancer screening programme DORA started inviting women in 2008 and finished national implementation in 2017. Women aged 50 to 69 are invited to attend screening mammography every 2 years. Mammography can show clinically occult impalpable breast lesions. In case of positive mammography test, women are invited for further assessment of lesions, and treated in case of a breast cancer diagnosis. Since 2018, screening mammographies are performed on 21 mammographic machines at 16 stationary and in 3 mobile screening centres. Additionally, further assessment and screen-detected cancer treatment take place at two screening and diagnostic centres at the Institute of Oncology Ljubljana and at the Maribor University Medical Centre. DORA programme follows European guidelines for quality control in screening from the very beginning and provides equal care for all invited women in all DORA screening units throughout Slovenia. The aim of the screening programme is to decrease breast cancer mortality rates in the target population by 25-30%, with precondition of 70% uptake. Slovenian programme effectiveness is proven by acceptable performance indicators\u27 results. Characteristics of Slovenian organized breast cancer screening are: centralized population-based programme, invitations with prefixed appointment for eligible women, double reading, consensus conference, further assessment is managed by screening programme, multidisciplinary meetings, screening registry with a special computer software for registration of all screening and assessment activities, quality assurance for radiologists and radiographers, regular quality control for programme providers, yearly monitoring of screening performance indicators

Quality assured implementation of the Slovenian breast cancer screening programme

SettingThe organised, population-based breast cancer screening programme in Slovenia began providing biennial mammography screening for women aged 50–69 in 2008. The programme has taken a comprehensive approach to quality assurance as recommended by the European guidelines for quality assurance in breast cancer screening and diagnosis (4th edition), including centralized assessment, training and supervision, and proactive monitoring of performance indicators. This report describes the progress of implementation and rollout from 2003 through 2019.MethodsThe screening protocol and key quality assurance procedures initiated during the planning from 2003 and rollout from 2008 of the screening programme, including training of the professional staff, are described. The organisational structure, gradual geographical rollout, and coverage by invitation and examination are presented.ResultsThe nationwide programme was up and running in all screening regions by the end of 2017, at which time the nationwide coverage by invitation and examination had reached 70% and 50%, respectively. Nationwide rollout of the population-based programme was complete by the end of 2019. By this time, coverage by invitation and examination had reached 98% and 76%, respectively. The participation rates consistently exceeded 70% from 2014 to 2019.ConclusionsThe successful implementation of the screening programme can be attributed to an independent central management, external guidance, and strict adherence to quality assurance procedures, all of which contributed to increasing governmental and popular support. The benefits of quality assurance have influenced all aspects of breast care and have provided a successful model for multidisciplinary management of other diseases.</p

Programske smernice DORA

Državni presejalni program za raka dojk DORA (v nadaljevanju: program DORA) vabi ženske med 50. in 69. letom vsaki dve leti na presejanje z mamografijo, katerega cilj je zmanjšati umrljivost za rakom dojk v ciljni populaciji za 25 do 30 odstotkov. Nosilec programa DORA je Onkološki inštitut Ljubljana. Presejalno mamografijo opravlja 16 javnih zdravstvenih zavodov po Sloveniji na 20 digitalnih mamografih s kadri, ki so za svoje delo posebej usposobljeni. Dodatno diagnostiko in zdravljenje raka dojk, odkritega v presejanju, izvajata presejalno-diagnostična centra na Onkološkem inštitutu Ljubljana in v Univerzitetnem kliničnem centru Maribor. Te programske smernice opredeljujejo presejalno politiko programa DORA, postopek obravnave žensk, organizacijo in dejavnosti programa DORA. Delijo se na upravljalske, zdravstvene in druge storitve. Sestavni del teh programskih smernic je tudi določitev strokovnega nadzora, ki se opravlja v presejalnem programu, ter podrobnejši Standardni operativni postopki (SOP) delovanja programa DORA. Sestavni del tega dokumenta so tudi Protokoli in priloge